A comparative study between standard and accelerated ponseti method in management of idiopathic congenital talipes equinovarus

Abstract

Introduction: Congenital Talipes Equinovarus is one of the most common congenital deformities of foot and ankle. Ponseti method of serial manipulation and once weekly casting has claimed a success rate of 95 %. However, modification of the Ponseti method in terms of duration with twice weekly casting can shorten the time immobilized in plaster with increased parents compliance. Materials and Methods: A randomized comparative study was carried out for total 64 patients (100 clubfoot) attending the Outpatient department of Orthopaedics, Silchar Medical College and Hospital from 1st June, 2017 to 31st May, 2018. 32 patients each in Standard Ponseti group and Accelerated Ponseti group were allotted according to computer generated randomisation plan. The method of manipulation was similar in both the groups with once weekly casting in Standard Ponseti group and twice weekly casting in Accelerated Ponseti group. The initial and final Pirani scores, number of casts required for correction, treatment time in plaster, rate of tenotomy and relapse of deformity in the Standard and Accelerated Ponseti groups were recorded and compared using paired and unpaired t-test methods as required. Results: The two groups did not differ with respect to their initial and final Pirani scores. The mean number of casts required was 5.92 + 1.09 in Standard Ponseti group, and 6.09 + 1.11 in Accelerated Ponseti group (p-value = 0.4203). However, there was significant difference in the treatment time in plaster with mean treatment time of 41.42+7.62 days(range -28 to56 days) in Standard Ponseti group and 21.13 +3.94days(range-14 to 31 days) in Accelerated Ponseti group with p-value < 0.05. 41 out of 48 feet in Standard Ponseti group and 46 out of 52 feet in Accelerated Ponseti group required percutaneous tenotomy. Relapse of equinus and adduction deformity was seen in 3 feet each in Standard and Accelerated Ponseti groups on follow up.Conclusion: Accelerated Ponseti method of twice weekly casting has similar results as Standard Ponseti method with the advantage of earlier correction of the deformity and better parents compliance.